Gait analysis and body composition after treatment of quadriceps tendon ruptures showed equal results independent of suture anchor or transosseus repair technique used: a pilot study

Hasenoehrl, Timothy; Palma, Stefano; Kéilani, Mohammad; Reschl, Martin; Vekszler, György; Ambrozy, Clemens; Plesser, Stefan; Hajdu, Stefan; Crevenna, Richard; Widhalm, Harald

doi:10.1080/09638288.2019.1611951

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…There was no difference in IKDC or Lysholm score between the different surgical techniques in this study population. Similar results have been previously described by Plesser et al in a smaller group of patients comparing transosseous refixation to suture anchors [ 15 ].…”

Section: Discussionsupporting

confidence: 90%

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Quadriceps Tendon Ruptures in Middle-Aged to Older Patients: A Retrospective Study on the Preoperative MRI Injury Patterns and Mid-Term Patient-Reported Outcome Measures

Loose

Rudolph

Schlösser

et al. 2023

JPM

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(1) Quadriceps tendon rupture (QTR) is a rare pathology, usually occurring in elderly patients with comorbidities, requiring surgical therapy. The aim of this study was to analyze rupture patterns and concomitant injuries using preoperative magnetic resonance imaging (MRI) and to evaluate patient-reported outcome measures. (2) In this retrospective cross-sectional study, 113 patients with QTR were screened and rupture patterns/concomitant injuries (n = 33) were analyzed via MRI. Clinical outcome was assessed in 45 patients using the International Knee Documentation (IKDC) and Lysholm score with a mean follow-up of 7.2 (±5.0) years. (3) The evaluation of preoperative MRIs showed multiple ruptures of subtendons in 67% with concomitant knee injuries in 45%. The most common associated pathology detected using MRI was pre-existing tendinosis (31.2%). Surgical refixation demonstrated good results with a mean post-operative IKDC score of 73.1 (±14.1) and mean Lysholm score of 84.2 (±16.1). Patient characteristics and individual radiologic rupture patterns did not significantly affect the clinical outcome of patients. (4) Acute QTRs are complex injuries with common involvement of multiple subtendons. MRI imaging can be useful for achieving an accurate diagnosis as pre-existing tendinosis as well as concomitant injuries are common, and might be useful for providing an individual surgical strategy and improving outcomes.

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Section: Discussionsupporting

confidence: 90%

“…Good clinical outcomes after QTR have been reported previously in several studies. Patients returned to their pre-injury activities despite advanced age and regardless of surgical technique used for fixation [ 15 , 16 ]. However, only few studies have focused on a middle-aged to older population [ 2 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Quadriceps Tendon Ruptures in Middle-Aged to Older Patients: A Retrospective Study on the Preoperative MRI Injury Patterns and Mid-Term Patient-Reported Outcome Measures

Loose

Rudolph

Schlösser

et al. 2023

JPM

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“…The proposed advantages of anchors are a smaller incision, less dissection and avoidance of fracture risk; however, there are increased costs related to the use of these implants. Nevertheless, both transosseous and suture anchor repairs report satisfactory outcomes in non-arthroplasty patients with high rates of return to activities of daily living and work ( 32 , 41 ) with no major difference in clinical outcomes ( 42 ) or gait analysis parameters ( 43 ). A recent systematic review of eight clinical studies has shown similar functional outcomes and re-rupture rates with transosseous sutures and suture anchors ( 44 ).…”

Section: Quadriceps Tendon Tearsmentioning

confidence: 99%

Extensor mechanism ruptures

et al. 2022

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Native patellar tendon injuries are seen in younger patients compared to quadriceps tendon ruptures. Up to a third of the patients may have local (antecedent tendinopathy and cortisone injections) or systemic risk factors (obesity, diabetes, hyperparathyroidism, chronic renal failure, fluoroquinolone or statin use) of injury, these are more frequent in bilateral disruptions. Complete extensor mechanism disruptions should be repaired surgically. Although isolated primary repair has been reported to have good outcomes in younger patients with acute tears and good tendon quality, augmentation of the repair with autograft, allograft or synthetic material should be considered in patients with poor tendon quality, chronic tears or tendon defects. High rates of return to work/sports have been reported in native patellar and quadriceps tendon tears, with re-rupture rates <5%. Extensor mechanism disruptions in patients with a total knee arthroplasty are challenging due to older age, systemic co-morbidities and poor local conditions, resulting in inferior outcomes compared to native extensor mechanism injuries. Some form of augmentation with autograft, allograft or synthetics is advisable in all cases. Salvage procedures such as whole extensor mechanism allografts provide acceptable outcomes in multiply operated knees with extensive bone and soft tissue deficits.

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“…The main role of the quadriceps muscle during gait is to support body weight during knee flexion. To date, there are no detailed data available on gait function following surgically or conservatively treated QTRs 25 . Here, we showed that a pre‐operative side‐to‐side deficit during knee flexion was resolved following surgical reconstruction of the quadriceps tendon.…”

Section: Discussionmentioning

confidence: 63%

“…To date, there are no detailed data available on gait function following surgically or conservatively treated QTRs. 25 Here, we showed that a pre-operative side-to-side deficit during knee flexion was resolved following surgical reconstruction of the quadriceps tendon. Considering the critical role of the quadriceps tendon during knee extension, 26 QTRs result in uncontrolled and excessive knee extension during non-weight-bearing swing phases 27 and should be reconstructed to ensure early return to function.…”

Section: Discussionmentioning

confidence: 79%

Intramuscular and intratendinous placenta‐derived mesenchymal stromal‐like cell treatment of a chronic quadriceps tendon rupture

Maleitzke

Reinke

Agres

et al. 2022

J cachexia sarcopenia muscle

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Background Quadriceps tendon ruptures (QTRs) are rare but debilitating injuries, often associated with chronic metabolic conditions or long‐term steroid treatment. While the surgical treatment for acute QTRs is described thoroughly, no common strategy exists for the often frustrating treatment of chronic, reoccurring QTRs. The pro‐angiogenic and immunomodulatory properties of placenta‐derived adherent mesenchymal stromal‐like (PLX‐PAD) cells have been described to protect musculoskeletal tissues from inflammation and catabolic cytokine migration, yet little is known about the regenerative potential of PLX‐PAD cells in repetitively damaged tendon tissue. Case We report the case of an 80‐year‐old male patient with a chronic three‐time QTR of his right knee. The quadriceps tendon was reconstructed applying a conventional suture anchor repair procedure combined with a synthetic mesh augmentation and additional intramuscular and intratendineous PLX‐PAD cell injections as an individualized treatment approach. No adverse events were reported, and excellent radiological and functional outcomes with a passive range of motion of 0/0/120° knee extension‐flexion were observed at the 12 month follow‐up. Gait analysis confirmed restoration of joint motion, including gait speed, deficit in step length, and knee extensor muscle strength (pre‐surgery: 0.98 m/s, 40 cm, 42.4 ± 12.4 N; 9 months post‐surgery: 1.07 m/s, 0 cm, 10.4 ± 18.9 N) as well as hyperextension throughout stance and late swing phases (pre‐surgery: −11.2 ± 0.9°; 9 months post‐surgery: −2.7 ± 1.6°). Postoperative lymphocyte and cytokine analyses from the patient's peripheral blood serum suggested a systemic short‐term immunoregulatory reaction with postoperatively increased interleukin (IL)‐6 (pre‐surgery: 0.79 pg/mL; day 1: 139.97 pg/mL; day 5: 5.58 pg/mL; 9 months: 1.76 pg/mL) and IL‐10 (pre‐surgery: 0.9 pg/mL; day 1: 1.21 pg/ mL; day 5: 0.3 pg/mL; 9 months: 0.34 pg/mL) levels that decreased again over time. Conclusions Herein, we demonstrate a successfully treated chronic QTR with a synergistic surgical and biological reconstructive treatment approach. This local add‐on treatment with PLX‐PAD cells may be considered in specific cases of chronic QTRs, not susceptible to traditional suture anchor procedures and which exhibit a high risk of treatment failure. Further scientific engagement is warranted to explore underlying immunomodulatory mechanisms of action behind PLX‐PAD cell treatment for tendon injuries.

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Gait analysis and body composition after treatment of quadriceps tendon ruptures showed equal results independent of suture anchor or transosseus repair technique used: a pilot study

Cited by 7 publications

References 24 publications

Quadriceps Tendon Ruptures in Middle-Aged to Older Patients: A Retrospective Study on the Preoperative MRI Injury Patterns and Mid-Term Patient-Reported Outcome Measures

Quadriceps Tendon Ruptures in Middle-Aged to Older Patients: A Retrospective Study on the Preoperative MRI Injury Patterns and Mid-Term Patient-Reported Outcome Measures

Extensor mechanism ruptures

Intramuscular and intratendinous placenta‐derived mesenchymal stromal‐like cell treatment of a chronic quadriceps tendon rupture

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